Nason Katie S, Schuchert Matthew J, Witteman Bart P L, Jobe Blair A
Division of Thoracic Surgery, The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 5200 Conte Avenue, Pittsburgh, PA 15232, USA.
Semin Thorac Cardiovasc Surg. 2008 Winter;20(4):320-5. doi: 10.1053/j.semtcvs.2008.11.014.
Endoscopic techniques for the treatment of reflux disease were first introduced in 2000 as an alternative to laparoscopic antireflux operations. Because of reports of long-term treatment failure with laparoscopic fundoplication and the fact that surgery is increasingly being reserved for the relatively small proportion of patients with complicated reflux disease, attempts to develop safe, effective, and durable endoscopic approaches to antireflux surgery continue. Techniques include radiofrequency ablation, injection therapy, and suturing/stapling techniques. Of these, the suturing/stapling techniques are most similar to the anatomic restructuring of the gastroesophageal junction provided by fundoplication. While early attempts at endoscopic suturing have been disappointing, significant advances in endoscopic instrumentation, a more complete understanding of the gastroesophageal junction anatomy, and improvements in the technical skills of the endoscopic surgeon have been realized. As a result, techniques now being tested, such as the endoluminal fundoplication, may prove more effective and durable than previous endoscopic antireflux procedures.
内镜治疗反流性疾病的技术于2000年首次引入，作为腹腔镜抗反流手术的替代方法。由于有腹腔镜胃底折叠术长期治疗失败的报道，且手术越来越多地仅用于治疗相对少数患有复杂性反流性疾病的患者，因此人们继续尝试开发安全、有效且持久的内镜抗反流手术方法。技术包括射频消融、注射治疗和缝合/吻合技术。其中，缝合/吻合技术与胃底折叠术所提供的胃食管交界处的解剖结构重建最为相似。虽然早期的内镜缝合尝试令人失望，但在内镜器械方面取得了重大进展，对胃食管交界处解剖结构有了更全面的了解，内镜外科医生的技术水平也有所提高。因此，目前正在测试的技术，如腔内胃底折叠术，可能比以前的内镜抗反流手术更有效、更持久。
